Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 17421 | MA |
N | 2251P0200X | Physical Therapist - Pediatrics | 17421 | MA |
NPI | 1104962364 |
---|---|
Provider Name | Amy L Davidson |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 20/08/2007 |